Recruiting resources?

[bigyeeter]

Hi,

I'm posting on behalf of a friend who is a psychologist that recently started up his own practice for ~psychology stuff~.

He's started to pick up quite a bit in volume, and has a lot of patients who definitely need to be seen by a psychiatrist. However, where he lives, psychiatrists are few and far between. He has started wondering if hiring a psychiatrist as a partial owner into his practice would be a feasible idea so that he can coordinate with the medical treatment easier. If this is something that can be done, he wants to know the best way to go about recruiting someone for this kind of setup.

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[TexasPhysician]

This generally isn’t a good idea. Counselors and psychologists can be quite busy with few total patients. Most psychiatrists need much higher volume. I could manage 100% of the psychiatric volume of 20+ FT counselors.

Additionally in some states it is illegal for psychologists to co-own a psychiatric practice.

 

[calvnandhobbs68]

This generally isn’t a good idea. Counselors and psychologists can be quite busy with few total patients. Most psychiatrists need much higher volume. I could manage 100% of the psychiatric volume of 20+ FT counselors.

Additionally in some states it is illegal for psychologists to co-own a psychiatric practice.

Agree it wouldn't even be worth it for a psychiatrist to come on board with one psychologist from the psychiatrist perspective, it'd be basically like opening your own private practice and the psychologist likely doesn't understand the infrastructure you need to manage hundreds of patients in terms of scheduling, medication stuff, etc. Most of the practices that have psychiatrists affiliated with them are pretty big...I actually work in that kind of setting and this group has a ton of therapists spread among multiple offices.

 

[Celexa]

Agreed this is not a full time gig for a psychiatrist. However, depending on the patient population, taking referrals from a particular therapy group could be a nice side gig a psychiatrist might be interested in, particularly if it were tele.

For a sense of the volume a psychiatrist is looking for, consider that most patients stable enough for outpatient only need to be seen every 4-6 weeks at MOST, when active med adjustments are being made. It simply takes that long to make an educated decision about next steps given the timelines the medications take to work. Stable patients can be spaced to every 3 months to one year depending on complexity/medical acuity/required lab monitoring. And a nice follow up pace is 30 min per.

Your friend can do some math to figure out what amount of a psychiatrist's time he's actually looking for. As others point out above, establishing such a relationship would not be about directly adding to his business per se. The psychiatrist would most likely need to operate as their own independent entity.

 

[Sushirolls]

I've seen groups founded by psychologists, who expand with a few psychologists, mostly masters level. Then once they are a bigger group they hire an ARNP and make them do their bidding. Every patient who gets diagnosed by the psychologists as ADHD with their "testing" - of course none are boarded or fellowship trained as neuropsychologists - gets a stimulant.

 

[bigyeeter]

Agreed this is not a full time gig for a psychiatrist. However, depending on the patient population, taking referrals from a particular therapy group could be a nice side gig a psychiatrist might be interested in, particularly if it were tele.

For a sense of the volume a psychiatrist is looking for, consider that most patients stable enough for outpatient only need to be seen every 4-6 weeks at MOST, when active med adjustments are being made. It simply takes that long to make an educated decision about next steps given the timelines the medications take to work. Stable patients can be spaced to every 3 months to one year depending on complexity/medical acuity/required lab monitoring. And a nice follow up pace is 30 min per.

Your friend can do some math to figure out what amount of a psychiatrist's time he's actually looking for. As others point out above, establishing such a relationship would not be about directly adding to his business per se. The psychiatrist would most likely need to operate as their own independent entity.

I think this is closer to what he was thinking. Establishing some kind of a relationship where things can be done more "in house", on a part time basis for the psychiatrist. Or frankly any kind of relationship to get easier access to an MD. As of current, he has no relationships with area MDs, the area MDs have no availability, etc.

I know that he doesn't want to partner with APRN because he frankly doesn't trust them, and he doesn't know anything about pharma such that he could have any reasonable insight into how appropriate their decisions would be. Telehealth could be a reasonable option, if there are any ideas on how he could integrate that?

 

[Celexa]

I think this is closer to what he was thinking. Establishing some kind of a relationship where things can be done more "in house", on a part time basis for the psychiatrist. Or frankly any kind of relationship to get easier access to an MD. As of current, he has no relationships with area MDs, the area MDs have no availability, etc.

I know that he doesn't want to partner with APRN because he frankly doesn't trust them, and he doesn't know anything about pharma such that he could have any reasonable insight into how appropriate their decisions would be. Telehealth could be a reasonable option, if there are any ideas on how he could integrate that?

If he wants to find this, he's going to need old fashioned shoe leather networking. Most people who are going to be interested in something like this are a) recent grads looking to set up their own private practice who would welcome a guarantees stream of referrals, or b) someone with a fairly cush employed position (maybe in academics) looking to make some extra money and/or a soft transition out to private practice. And then c) you're going to need someone who is interested in doing the med side of whatever type of work your friend does, and have enough discussions to feel a mutual sense of respect.

It'll take patience, but he might be successful networking with residency programs in the state (do they need supervisors? I had psychologist therapy supervisors in training) or going to a state psychiatric society meeting.

This is actually the basis I am using for my own private pracrice starting next year. I found the therapy group I will be working with purely through informal word of mouth. I will get referrals of patients who have shown commitment to therapy, they will get a psychiatrist who is reachable. There will not be a direct financial relationship.

 

[Candidate2017]

Most of the large psychiatric clinics I know are owned by therapists (psychologists or even social workers) who built up a client base, added more therapists, and then finally hired psychiatrists. They do quite well, earning a million +/-. Generally, most psychiatrists have no clue or interest in starting practices. Doctors are too burdened with student loans, too risk averse, too concerned with practicing medicine, too OCPD, know too much, and have too much income guarantee as employees. Therapists generally lack those things, have nothing to lose and need to start a practice if they hope for an income that approaches 6 figures, and the ones with business acumen rise to the top.

Additionally in some states it is illegal for psychologists to co-own a psychiatric practice.

This is an example of doctors being risk averse and knowing too much. But illegal vs. policed vs. prosecuted vs. punished vs. punished severely are different things. When was the last time a nurse or psychologist got punished for stepping into our realm? You're more likely to get a ticket for doing 67 in a 55 mph zone.

Business people weigh legal risks vs. monetary benefits all the time (see online pill mills). I've also no doubt large clinic owners can retrofit their clinics into being legal with help from lawyers.

 

[TexasPhysician]

Most of the large psychiatric clinics I know are owned by therapists (psychologists or even social workers) who built up a client base, added more therapists, and then finally hired psychiatrists. They do quite well, earning a million +/-. Generally, most psychiatrists have no clue or interest in starting practices. Doctors are too burdened with student loans, too risk averse, too concerned with practicing medicine, too OCPD, know too much, and have too much income guarantee as employees. Therapists generally lack those things, have nothing to lose and need to start a practice if they hope for an income that approaches 6 figures, and the ones with business acumen rise to the top.



This is an example of doctors being risk averse and knowing too much. But illegal vs. policed vs. prosecuted vs. punished vs. punished severely are different things. When was the last time a nurse or psychologist got punished for stepping into our realm? You're more likely to get a ticket for doing 67 in a 55 mph zone.

Business people weigh legal risks vs. monetary benefits all the time (see online pill mills). I've also no doubt large clinic owners can retrofit their clinics into being legal with help from lawyers.

I’ve only seen the opposite. In my area, it is the psychiatrists that are growing practices and adding counselors and psychologists. The few counselors trying to get into this realm have no idea what it requires. They have offers for $120/hr on Indeed trying to find some psychiatrist for years. Some have added a NP at 5 hours/week and try to push everyone into those hours. I get many of the patients that get tired of this situation.

I have reported a physician that had a business with a nurse, and the practice had to restructure. Sure there are complicated ways around it, but 1-2 psychologist/counselor clinics don’t have the resources to structure that and bring on a psychiatrist in my experience.